Mar 22, 2018

Comprehensive action on surgical waiting times is good news for BC

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The case for bold, evidence-based action on surgical waiting times—especially for hip and knee replacements that are among the longest in the country—is clear.

That is why the BC government’s move to take decisive action to reduce surgical waiting times throughout the province is very good news for all British Columbians.

Data reported by the Canadian Institute for Health Information demonstrates why we need a new comprehensive surgical strategy in BC. In 2016, only 47 per cent of knee replacement patients received surgery within the recommended time—a steep decline from the 74 per cent that met the benchmark in 2012.

Too many British Columbians wait too long for the care and supports they need. It doesn’t have to be this way and we are pleased to see the government’s new approach tackling this long-standing health care challenge.

In 2016, the Canadian Centre for Policy Alternatives’ report, Reducing Surgical Wait Times: The Case for Public Innovation and Provincial Leadership, ­raised concerns about the former BC government’s pursuit of changes that would allow more complex surgeries (those requiring up to three-day stays) to be performed in private for-profit surgical clinics.

Based on a review of Canadian and international evidence, this direction would be more costly to the public purse, less safe for patients and would destabilize the public health system—a direction that would send BC down the wrong path.

A provincial surgical strategy must increase the number of surgeries completed in the public system, while also making more efficient use of existing operating rooms and pre- and post-surgical services.

The CCPA report also stressed that a provincial surgical strategy must increase the number of surgeries completed in the public system, while also making more efficient use of existing operating rooms and pre- and post-surgical services.

It is encouraging to see that the new provincial surgical strategy will do just that. More surgeries will be completed beginning with hip and knee joint replacements—an area where there is significant demand. Importantly, the government is thinking beyond the short-term strategies that failed in the past. Health authorities will complete 9,400 additional surgeries by March 2019 to catch up on backlogs while keeping up with demand.

The CCPA report also focused on the key ingredients necessary to sustain wait time improvements based on international research evidence and what has worked in BC.

Specifically, we looked at a number of past health authority strategies that had reduced surgical waiting times and improved care in BC. These were often led by local groups of surgeons, administrators and front line health care professionals. Until now, they had not been expanded province-wide to benefit all British Columbians who require hip and knee surgery.

We are pleased to see that the just announced surgical strategy adopts many of the evidence-based practices identified in the CCPA research report.

  • The use of assessment and triage teams (piloted successfully by Vancouver Coastal Health) and staffed with physiotherapists and other health care professionals to rapidly assess patients’ appropriateness for surgery thereby substantially reducing the time it takes to see a surgeon.
  • Centralizing wait-lists for orthopaedic surgeons who do these procedures, which will allow patients the option to see the first available surgeon in a given region.
  • Using specialized teams of health professionals to adequately prepare patients for surgery, thereby reducing the likelihood that surgeries will be cancelled.
  • Ensuring comprehensive physical rehabilitation support after surgery to reduce hospital stays.
  • Using more than one operating room and staggering schedules to allow surgeons to begin their next case in a timely way and not have to wait until an operating room is vacated and prepared after the last completed surgery.

With provincial leadership and this strong foundation for improvement, British Columbians will benefit from this surgical strategy that takes research evidence seriously and implements proven solutions to reduce waiting times. This is good for public health care in British Columbia.

This article originally appeared in the Vancouver Sun